Children will replace their milk teeth between the ages of 6 and 14 years old, and will have mild teeth grinding during this time because of itchy gums. Teeth grinding in children can affect the local development of the child’s body and destroy the aesthetics of the child’s teeth. Sleep teeth grinding has a high incidence in pediatric and adolescent youths, up to about 15% according to medical statistics. With the growth of age and the gradual improvement of brain function, its attack rate will decline year by year and heal itself when it grows up.
I. Clinical manifestations
Mainly rhythmic, intermittent jaw grinding or prolonged muscle clenching state. Nocturnal molar can produce huge biting force, far more than the force of conscious biting. As a result, the dentition, alveolar bone, periodontal supporting tissues and temporomandibular joints bear an excessive load. The most common clinical injury in bruxism is tooth wear, which can also lead to other symptoms in the teeth or supporting tissues, such as high sensitivity to hot and cold stimuli, tooth loosening, periodontal tissue damage, dental osteophytes, cusp fracture, and pulp necrosis. Due to excessive force, patients with molar disease often show masticatory muscle fatigue, pressure pain, abnormal function and muscle tension pain.
Second, the causative factors
The causative factors so far have not been fully clarified, and the factors found so far include mental factors, occlusal factors, neuromuscular dysfunction of the masticatory muscle system and other factors such as endocrine disorders, genetics, etc. Most scholars believe that the disease is caused by a multifactorial synergy.
1. Sleeping posture
Nocturnal teeth grinding in children has a certain relationship with sleep posture. During sleep, the whole body muscles are relaxed, but when children are in the prone position, the jaw will be under the pressure of the head. In order to get rid of the pressure on the lower jaw, that can produce grinding, the formation of night grinding teeth. If the child constantly turns his body or changes his sleeping position during sleep, it will also produce a transient night molar.
Parents should be instructed to let their children develop good sleep habits and not to fix a sleep position, otherwise it may not only lead to or aggravate the night grinding symptoms, but also have an impact on the child’s head and facial development.
2. Genetic factors
Genetic analysis shows that it should be an autosomal dominant inheritance. Teeth grinding has a certain persistence, childhood night grinding often persists in adulthood, children and adult teeth grinding is positively correlated, genetic factors can not be ignored.
3. Dental abnormalities
Children are in the period of tooth replacement, with the loss of milk teeth and the eruption of permanent teeth, the occlusal relationship is relatively unstable, there will be some temporary occlusal disorders, such as temporary crowding when the permanent incisors first erupt, the gap between the maxillary central incisors, the first molars of the upper and lower jaws to build the initial cusp-to-cusp occlusal relationship, temporary deep overlap of the anterior teeth, etc., easy to appear interference, but this relationship will be adjusted by itself with the gradual eruption of permanent teeth. Some children do have occlusal problems such as crowding of the milk teeth, anticlinal, inwardly inclined deep overlap, deep overlap, open, etc. These problems will not improve on their own with the building process, but will affect the development of the child. This intention to form a chewing muscle spasm and contraction triggers teeth grinding.
4. Craniomaxillofacial morphological factors
The craniofacial morphological development in childhood has a certain time pattern and reaches a more stable state in pre-puberty, while the use of removable prostheses, poor recovery of filling form, poor orthodontic program design, improper force, bad chewing habits such as lateral chewing, teeth grinding, etc., may cause the craniofacial development of bony deviation.
5. Spiritual and psychological factors
Mental tension can increase the tension of the closed jaw muscles, especially the anxious, trying to relieve the depression in their hearts by grinding their teeth, and these patients have a long and frequent tooth contact.
6. Nervous system factors
After sleep, due to the inhibition of the cerebral cortex, the subconscious jaw closing reflex increases, muscle tension and the rhythm of contraction are changed, appearing clenching type and grinding type of activity, after waking up, teeth grinding is controlled.
7. Systemic factors
Gastrointestinal disorders, endocrine imbalance such as hyperthyroidism, zinc deficiency, blood pressure fluctuations, metabolic reactions, the role of histamine and some histamine-like substances in the body tension process, etc. may cause night grinding.
In addition, children suffering from rickets, due to the lack of vitamin D in the body, malabsorption of the mineral calcium. In order to cause the child not only in the formative years appear square head, the lower edge of the ribs turned out, chicken chest and other skeletal symptoms, but also sweating, night terrors, irritability and other neurological symptoms, grinding teeth at night is also one of the symptoms.
8. Intestinal parasites
Intestinal parasitic infections are common in children, and parasitic infections are common in roundworms. The activities of parasites and the toxins and metabolites they secrete enter the body and stimulate the corresponding parts of the brain of the sleeping person, causing spasm or continuous contraction of the chewing muscles, which can reflexively cause night grinding of teeth. Some scholars believe that teeth grinding in children is not related to intestinal parasitic infection, but there is a lack of strict control experiments and epidemiological investigation data.
Treatment of teeth grinding disorder
Due to the differences in the understanding of the etiology, most of the current treatment is symptomatic, and the treatment method is still mainly based on occlusal plate treatment, psychotherapy, muscle relaxation treatment, tooth adjustment and drug treatment.
1. Psychotherapy
Give comfort and guidance to patients from the mind, relieve their concerns and stress, reduce tension, self-referral, muscle relaxation training, measures to relieve mental stress include biofeedback, muscle relaxation, psychological counseling, hypnotherapy and so on. In addition, we should avoid drinking alcohol, smoking, tea, coffee and beverages before going to bed, improve the sleep environment, gradually relax and change our lifestyle.
2. Adjustment treatment
To remove the occlusal interference by adjusting and grinding a small amount of dental tissues, to establish the natural tooth balance, to achieve the physiological balance between the occlusion, masticatory muscles and temporomandibular joint, and to eliminate teeth grinding.
3. Use muscle relaxation device
Excessive tension in the jaw muscles is one of the causes of teeth grinding, and the release of excessive muscle tension in treatment is a necessary means to control teeth grinding. Commonly used methods include: the application of muscle relaxation apparatus, physical therapy, physiological function training of masticatory muscles, massage and audio-visual suggestion, etc.
4. Application of occlusal plates
Bite plate treatment for teeth grinding is faster than other physical methods, and can continue to relax the muscles. In addition to mechanically isolating the direct contact between upper and lower teeth, preventing the occurrence of teeth grinding, avoiding continued damage to the dental and periodontal tissues, it can also cut off abnormal dental interference, adjust the joint and jaw position, and improve muscle tension, so that the function of the entire mouth and jaw system can be gradually restored.
Growing children are under a lot of pressure due to the constant changes in various aspects, and the changes in tooth alignment especially increase the pressure, so once the transition period is over, most children will stop grinding their teeth. Finally, parents are reminded that when they find that their children are grinding their teeth, it is best to ask a physician to evaluate and rule out possible systemic factors, then return to the clinic on a regular basis, closely observe, and give the children adequate physical and psychological support, which is the most appropriate treatment.
Fourth, Chinese medicine treatment
Chinese medicine believes that teeth grinding is mostly caused by intestinal parasites or disharmony of the spleen and stomach. “If the stomach is not in harmony, the night is restless”.
According to the age of the child, see if there are abnormalities in the spleen and stomach function, and give drugs to harmonize the spleen and stomach or deworming medicine.